How to Apply

Before a “Friend” can be accepted into the program, he/she must have:

1. Completed Application Form on File

Completed applications may be returned to:

ADS Application 2017

Alzheimer’s & Dementia Services of Memphis, Inc.
3185 Hickory Hill Road
Memphis, TN 38115-2533


2. Certification by a Physician

Certification by a physician of a diagnosis of Alzheimer’s disease or another related dementia on file. This form is included in the application packet. Have the physician fill it out. You may return it to us, or the physician’s office may fax it to us at (901) 370-5642. A diagnosis of some form of dementia must be listed.

3. Certification of Freedom

Certification of freedom from communicable disease on file. This is on the physician’s statement.

4. Pre-enrollment Visit

Pre-enrollment visit of applicant and primary caregiver is part of the application process. During pre-enrollment visit, a functional assessment of the applicant is conducted. The pre-enrollment visit will be scheduled once the application forms are all received and days are available for admission. This visit is required before admission into program.

Alzheimer’s & Dementia Services of Memphis, Inc. accepts “Friends” who have been diagnosed as having Alzheimer’s disease or a related disorder causing irreversible dementia. Services are also available to the victims of dementia as a result of:

  • Multi-infarct dementia
  • Stroke
  • Multiple sclerosis
  • Parkinson’s disease
  • Brain injury
  • Drug or alcohol abuse
  • Other causes certified by a physician’s statement

Alzheimer’s & Dementia Services of Memphis, Inc. is a social model day program and has additional admission criteria to ensure that the ADS program is an appropriate care option for families while maintaining the safety and well being of “Friends” and personnel. A list of these criteria can be furnished upon request.

It is the policy of this agency to provide services to all individuals whose needs may be met by our services and who meet admission criteria, without regard to race, creed, age, sex, national origin, or color.

The pre-enrollment visit determines the prospective “Friend” eligibility for admission. This visit also allows the caregiver to meet individually with a member of the administrative staff to discuss the prospective “Friend’s” needs and administrative policies that will directly impact the “Friend”. This is the first step in developing an individualized plan of care for each person who attends Alzheimer’s & Dementia Services of Memphis, Inc. and providing relief to their caregivers and support for their families.